Prevention
Actionable business intelligence. This is the difference between knowing an overpayment issue exists and understanding why the overpayments are occurring and how to prevent repeating them in the future. This is also what Calypso provides our clients as the corner-stone of our prevention process.
Components of the Calypso Prevention Process
Quick Hit Quality Improvements: Through the analysis and validation of suspect overpayments, process and system errors are rapidly identified and communicated back to the client for immediate quality improvement.
Overpayment Trending and Analysis: Using our discovery and recovery technologies, Calypso provides clients with consolidated reporting on overpayment trends. From this, we can perform root-cause analysis and develop an actionable roadmap of recommendations to address the sources of overpayments.
Claims Payment Accuracy Audits: An independent and comprehensive analysis of paid claims data is performed to identify quality issues. Audit requirements can include specific lines of business, claims systems, or an entire set of data from a specific time frame. An actionable roadmap of recommendations is then developed by Calypso to address and resolve the sources of errors.
Claims System Conversion Risk Mitigation: During claims system conversions, health plans can experience reduced claims payment quality and increased overpayments due to a multitude of reasons. Calypso's focused approach is to review claims data to quickly identify the root cause of errors and recommend steps to resolve the errors moving forward. Working with our clients, we are able to achieve significant improvements in claims payment accuracy while allowing our client to focus on maintaining member and provider satisfaction.